Goals when things are changing

Type 1 & LADA New T1/LADA
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So while I’m stuck in bed, I actually have time to write this post…

The past two weeks have been difficult. I weaned my son, my husband was in the hospital, my BG has not been great. I believe hormonal/GI changes due to weaning are primarily to blame, though stress certainly doesn’t help. I’ve been relying on Afrezza a lot so as not to have to spend time/mental energy calculating carbs, measuring portions, prebolusing, etc. I’ve noticed, though, that almost everything I eat now outlasts the Afrezza, which I think is because my metabolism has slowed now that I’m no longer breastfeeding - food is taking longer to digest. So I now have to work on dosing strategies for everything, double check ratios, etc. However, with all the current stressors, I don’t feel I have the mental energy to even deal with all of this right now. I have had to figure things out on my own from the beginning, and I’m just tired of it.

Any tips for smaller goals to work on that lead up to the ultimate goal of figuring out new ICR/dosing strategies for pretty much everything? I get easily discouraged when my BG isn’t in range (goal range is 70-140). It’s been suggested to me that I need to loosen up a bit to get through this, but I always worry about complications. I know what’s ideal, but what is a realistic goal range to go for that might help me not be worried about long term damage? I’m hitting 160-180s at least once daily right now (and sometimes up to low 200s), whereas before it was almost effortless to stay below 140.

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I think loosening your BG goal temporarily is a good idea. I’ve had insanely crazy blood sugars since my Tresiba experiment, and I’ve also been feeling like crap in general (allergies, extreme fatigue, etc., etc.). I’m honestly struggling just to get through the day and to get up and get the bus to work instead of sleeping in and getting cabs. My usual goal is 4-7 mmol/L (70-125 mg/dl), but I’ve recently change that to 4-10 mmol/L (70-180 mg/dl), and I’ll probably keep it there for at least the next couple of weeks. Having slightly high blood sugars for a short period of time is not going to cause complications. Complications result from years and years of high blood sugars.

I hope you’re able to find your new settings and find life in general less stressful soon!

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@Pianoplayer7008, I am really sorry to hear what you have to go through right now. and that is all on top of D!

I don’t think you should “loosen up”! For sure, it is best to learn to let bygones be bygones: everything that happened up to the minute that is just past, is gone, and better forgotten in terms of guilt and performance. But, to me, being successful at this (or almost anything) means intensely wanting to do it right, and intensely doing it right, while not allocating any more importance than it needs to be in your life. I think it is only by working hard at D that we can all progress in our technical dominance of the subject. People like @Eric can do all of what we do practically in their sleep because they are so practiced at it.

At the same time, D is not our life, either. We have to be intense in D things, but, imho, we should not let it take over our lives. We work very hard, at home, to give my son a normal childhood. He has to work harder than other kids for that, true, but that is the nature of the beast. He still gets to be a kid, and go airsofting in the woods every week, swimming, running, going on sleepovers etc.

I hope I make sense when explaining what I believe—and I understand that others may have a very different thought on this, of course.

I think the transition from honeymoon to full T1 status is the hardest, because nothing is stable, and everything changes massively. So you are probably right now very challenged and will be until you have made a full transition. So I think you need to keep in mind that it will get better.

That said, these are some thoughts on how to deal with the day. The rock of BG control, imho, is your daily basal rate. Everything else is easier if your basal is good, because you don’t have to fight either too much or too little insulin. So trying to be in good control of your basal, in particular as it is changing right now, a tough task, is very helpful.

As for ICRs, I wouldn’t try to figure out really hard things right now. Essentially, for us, the only really hard things to dose for have a combination of high carbs, high fat and high protein. So, unless we are ready for a big D party, we just don’t eat that. For instance:

  • like @kmichel suggested, we eat cauliflower pizza if we have a craving

  • we typically stay around 40-60 carbs most meals, and eat a lot of low GI foods such as veggies and pulses (pulses have very low GI so they will always outlast Afrezza btw, but they won’t give you tough rises either I think). We don’t use enormous amounts of fat, but we consume lots of protein. All in all, these are not challenging meals in general.

So, in essence, we have more or less one ICR, and, most of the time, we avoid “complicated” D meals when we are rushing through the day.

Wish I could help you more :frowning: Hopefully, some others will come up with some great suggestions.

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Pretty assuredly. I know that stress is not my bg friend.

My suggestion is to watch your glucose levels after eating, and if you are starting to riss (or are rising) 20 minutes after you dose Afrezza, do a follow up dose. Try another 4 unit cartridge and see if that helps you get back to range sooner.

At least that is where I suggest starting.

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It just sucks basically… Just went thru end of honeymoon type stuff too. Is what it is and you do the best you can. Don’t beat yourself up too much right now. Its tough and it will level out again. I hope. I’ve been in therapy for years over my superhuman ability to beat myself up.

Probably time to get on/up basal. and carefully adjust ratios (but those change with the random bursts of pancreas activity so its a lottery whether you stay high or get random <40 lows so high is safer in the short term). But ugh it stinks. Best you can do right now with the transition might be 50-200. But its temporary. I got my a1c from 12.5 to 5.5 in 2.5 months but I think the one I’m getting soon might be 6. It is what it is and I couldn’t do better without really screwing up everything else and being super unhappy and stressed about it. You got this. Hugs.

It always seems like when you get sick or feel awful for whatever unrelated reason the numbers just get that much worse when you don’t feel like dealing with it and can’t add 2+2 in your head much less count carbs and calculate doses. I’ve just had to be nice to myself on days like that and not beat myself up over the 200s since it doesn’t really happen that often in the grand scheme of things. Lots of hugs and doggie snuggles from Watson. Feel your pain here.

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It’s pretty near impossible to not get stressed, grumpy, whatever when BG is high and still heading up. The way I handle the bad spells is take it one high BG at a time. That means (to me) drop everything and work that high back down to the target range as quickly as possible. Mentally I shift from the long term goal of “always” staying in target BG to the immediate goal of correction bolus, brisk walks, staring at CGM, more correction bolus, staying on my feet, etc until I’ve dropped back to about 150, then I can mellow out and get back to whatever I was doing before diabetes interrupted my life.

Highs make me pretty grouchy so my wife instinctively senses when I am stressing out over a rising BG and minimizes the distractions. The worst for me are on long drives. I want to pull over and get on my feet until the BG trend turns downward. When I have time, I’ve done it. Rising high BG makes me mad at myself for sitting on my butt, and standing/walking helps the correction bolus work it’s magic and helps my attitude.

I did a poll thread a few months ago asking how many times a week people go over 200. Check it out, the responses gave me the impression it’s something that will unavoidably happen despite our best efforts.

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This is what I’m struggling with. I’ve become depressed over the worse control and been beating myself up over every high I don’t catch (@CarolynA, I can so relate to the superhuman ability to beat yourself up thing…).

This is the second part of my problem - I was glutened a month ago, and in an effort to help my gut heal and with stomach issues resurfacing as I weaned baby, I cut out all grains, dairy, eggs except baked in things, and almost all sugar. My blood sugar was great (as long as I didn’t eat any potatoes, which was unrealistic because I need carbs for my muscle disorder…), but that diet isn’t sustainable when life is busy/stressful and finances are tight. I still have to avoid dairy, eggs, and avocados right now because of the stomach issues, which is making my diet very difficult in terms of eating enough to satiate hunger but not spike BG.

Thanks, I’ll try that. The difficulty there is I only get 90 cartridges per month, so I have to be judicious in using multiple doses for one meal.

Heh, yep, I just got a 4.9 in Dec and am sure I’m back up in the 5s again now, which isn’t terrible, but again, hard to beat myself up when I know I “could” get to the 4.9 because I just did that.

I should work on that.

Thanks! I remember seeing it, but at the time I wasn’t hitting 200 pretty much at all, so I didn’t pay much attention to the responses aside from a cursory glance.

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@Pianoplayer7008, I think striving for good control is important, but I am worried you are focused on the wrong thing. Specifically this statement makes me a little nervous for you:

You have impeccable control, in my opinion you shouldn’t be worried about doing damage every time your bg goes above a certain number. As long as the excursions are short, you are just fine. Even glucose normals have excursions above 140.

You are doing great, just hang in there. You have a lot going on, and everyone would be stressed in the same situation. Also, stress is a bad time to try and titrate. My son going through finals this year was all over the place, the minute the finals ended, bam, perfect control. I think the best thing you can do for yourself is simplify what you are eating, treat as best you can, and wait until the stress of the situation resolves, then dig in to titrating your situation. We always start with basal, go to dinner next, then lunch, and end with breakfast ratios.

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Thank you, @Chris. I think my attitude is partially influenced by being so “new” to all of this, and being a perfectionist prone to worry. I’m working on that 2nd part. :wink:

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What about carbohydrates from fruit? Sweet potatoes? Just as a note, I tried the whole 30 along time ago (which is basically the diet that you described above) and I think while it had some good points, I fell into a severe depression very quickly because I wasn’t eating enough carbohydrates. Once I added sweet potatoes, I was fine.

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@Pianoplayer7008, @Chris did a great job at summarizing what I feel too: when we go from honeymoon to regular, control worsens a bit in some ways (only in some ways, and only so much), and small variations count for less. I feel 100% certain that you will be among those who have outstanding control because they fully master technical BG management. Even if you were not a natural at it (which I think you are), your being a forum member probably gives you a 1.5% A1c advantage, because people are here are so technical that we all gain a lot from each other.

Only on FUD would somewhat complain of that, of course:slight_smile: But I am not making fun at all: I think if one can get there, one should, as long as the life cost is not too great.

Do you get good support at home for D?

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I do, even from my 3yo. :slightly_smiling_face: The hardest part is support where food is concerned - I don’t want anyone around me to change how they eat, of course, but it is difficult when others are eating things I used to eat and enjoy, and particularly when they go out of their way to offer or make/buy something to/for me. Or when choosing restaurants to go to as a family (our options are already severely limited due to celiac disease considerations). It’s harder to resist, even knowing the consequences.

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Somehow missed your post, @TravelingOn. Yes, I was doing a “modified” whole30 (modified because of my carb needs - left in legumes). I haven’t managed to dial in the proper dose for sweet potatoes, with either Novolog or Afrezza (spike too fast for Novolog despite 45 min prebolus, and have delayed spike with Afrezza). White potatoes, either, really, unless they are cold in a potato salad. I haven’t bothered with many fruits, either - I eat berries and apples, citrus on occasion, but bananas and grapes, in particular, have proven almost impossible to figure out as well. That’s where most of my frustration is coming from - I have so many things I need to figure out how to dose for, but don’t have the mental energy to devote to it, especially since I know I’ll have many highs before I get it. :slightly_frowning_face: I really need to break things down and tackle one food at a time, but I’m a “go big or go home” kind of person when it comes to tackling things, so it’s hard to reign that in properly.

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Fascinating! I assume it’s because the starch is boiled out of them due to the cooking method I understand potato salad uses. EH avoids them. He also avoids grapes for the reasons you stated - impossible to figure out.

I do hope you get it dialed in for your own peace of mind. But I will say I hope you go easy on yourself and avoid burnout. I think it’s real for adults as well as teens. :frowning:

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Probably it’s more that some of the starch is converted to resistant starch, which happens with cold potatoes and cold rice and pasta. (It converts back to regular starch if you reheat it though.—correction: actually, was looking that up to confirm it, and sources are mixed. Some say resistant starch will be retained once the food is cooked and cooled even if reheated, some not.)

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While boiling does change the starch compared to, say, baking (which is why sweet potatoes are SO much sweeter baked than boiled - the cooking methods actually do impact the starch), it’s the conversion to resistant starch like @cardamom says. In my (limited) experience, cold potatoes/pasta have the least impact on BG, and cooled then reheated have less impact than when first cooked, so I don’t think reheating fully converts it back, but it does raise my BG higher than if I kept it cold. We eat a lot of potato/pasta salads here. :slightly_smiling_face:

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Thought of the resistant starch discussion this morning…had a big salad and a small bowl of (cold) mashed boiled sweet potatoes for breakfast, dosed a 4u Afrezza…and I went low after the initial (very brief) rise. I don’t go low when those sweet potatoes are reheated, and especially not when they’re first cooked. Cold sweet potatoes may become one of my new favorite foods. :wink:

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I’ve got a great memory of cold sweet potato salad from my college days. When I moved away, I called them and begged for the recipe. I don’t have it at my finger tips, but it goes something like this:

Cubed, roasted sweet potatoes, cooled
A tiny bit of thinly sliced red onion
Dijon mustard
Honey
Olive oil
Salt & Pepper
Italian Parsley, minced

Maybe I’ll make it next week!

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Looks good, if your sweet potatoes are good ones, I bet you can drop the honey and they will still be delicious. Will have to give it a try.

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It took me a while to remember where I’d seen it, but here’s another recipe that uses chilled cooked sweet potatoes. None of the other ingredients add any carb. We made this regularly one summer and then it dropped off the radar. Note it serves 16 but it’s easy to cut down.

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